Provider Demographics
NPI:1083862718
Name:BURDETTE, TARINA MICHELE (RCP, RRT)
Entity Type:Individual
Prefix:
First Name:TARINA
Middle Name:MICHELE
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:RCP, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 MAIN ST # 1402
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5658
Mailing Address - Country:US
Mailing Address - Phone:713-408-4794
Mailing Address - Fax:
Practice Address - Street 1:11315 MAIN ST # 1402
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5658
Practice Address - Country:US
Practice Address - Phone:713-408-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84858227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered